Provider Demographics
NPI:1841597507
Name:SISK-FANDRICH, DUSTI JO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DUSTI
Middle Name:JO
Last Name:SISK-FANDRICH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5945
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22403-5945
Mailing Address - Country:US
Mailing Address - Phone:540-681-1669
Mailing Address - Fax:
Practice Address - Street 1:615 JEFFERSON DAVIS HWY STE 203
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8407
Practice Address - Country:US
Practice Address - Phone:540-737-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-16
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist